Patients with operable stage I non-small cell lung cancer (NSCLC) could achieve better overall survival rates if treated with stereotactic ablative radiotherapy (SABR) rather than the current standard of care, which is invasive surgery. This research from a phase III randomized international study was published in The Lancet Oncology (2015; doi:10.1016/S1470-2045(15)70168-3). These findings are from the first randomized clinical trials comparing SABR and surgery.

“For the first time, we can say that the two therapies are at least equally effective, and that SABR appears to be better tolerated and might lead to better survival outcomes for these patients,” said the first author and principal investigator Joe Y. Chang, MD, PhD, professor, Radiation Oncology at The University of Texas MD Anderson Cancer Center in Houston.

“Stereotactic radiation treatment is a relatively new approach for operable early stage lung cancer, while surgery has been the standard for a century. This study can give physicians confidence to consider a noninvasive option.”

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The researchers analyzed overall survival, recurrences, and toxicity in 58 patients. Estimated 3-year survival rates were 79% in the surgery group and 95% percent in the SABR group, while recurrence-free survival rates at 3 years were 80% and 86%, respectively. Six patients in the surgery group died versus one death within the SABR group. None of the patients treated with SABR had high-grade toxicity.

The authors suggested that the lower survival rate following surgery could be attributed to other simultaneous conditions that were worsened by the surgical reduction of lung function. As such, the findings support SABR as a noninvasive alternative, especially for elderly patients and for those with significant comorbidities.

According to the Centers for Disease Control and Prevention (CDC), lung cancer is the leading cancer killer in both men and women in the United States. The American Cancer Society reports that more than half of people with lung cancer die within 1 year of diagnosis, and, according to the National Cancer Institute, an estimated 158,040 Americans are expected to die from the disease in 2015.

Over the last decade, SABR has been used to treat patients with inoperable NSCLC, showing outcomes that are better in some cases than traditional radiation. However, there has been no data on SABR for patients with operable early stage NSCLC because of concerns about the risk of recurrence after SABR. Surgery on the other hand, including lobectomy with dissection of the lymph nodes, was thought to have less chance for cancer to recur.

However, lung cancer surgery is a major operation with a high complication rate, and while recurrence rates are low, there is a 10% to 20% chance the cancer will recur in the other lobes, regional lymph nodes, or distant organs, noted Chang. Results in this study show no difference between SABR and surgery for tumor recurrence.

Chang added that these findings should be interpreted with some caution, due to the small patient sample size and limited follow-up time. Two new randomized studies are in preparation and are expected to open in 2015.